Participant Decision Support Checklist
Guide a practical support conversation through location, household, ICHRA offer, subsidy/CSR, plan/network/drug, enrollment/payment, and decision documentation.
Purpose
Guide a practical support conversation through location, household, ICHRA offer, subsidy/CSR, plan/network/drug, enrollment/payment, and decision documentation.
When to use
Use during employee support conversations, plan shopping support, enrollment reminders, or escalation triage.
Who should use this
Employee support owner, HR, broker/advisor, enrollment support partner, or HRB designee.
Review boundary
This checklist supports structured participant guidance. It does not authorize unlicensed plan advice, legal advice, tax advice, Medicare advice, or compliance determinations.
Resource sections
Confirm location and household context
- Confirm location relevant to plan availability.
- Flag household/tax-family questions for qualified support.
- Avoid over-collecting sensitive details.
Review ICHRA offer and affordability status
- Reference offer amount and affordability result if available.
- Route affordability questions.
- Retain evidence location.
Check subsidy/CSR implications
- Flag APTC/CSR questions.
- Link coordination worksheet if needed.
- Route tax/Marketplace questions.
Compare plan type, network, providers, and drugs
- Use plan-selection and verification resources.
- Check provider/drug issues by source/date.
- Route recommendation requests to licensed support.
Confirm enrollment path
- Identify enrollment path and deadline.
- Flag exchange/off-exchange decision needs.
- Record confirmation location.
Confirm premium payment path
- Confirm first premium and ongoing payment responsibility.
- Flag payment-risk escalation.
- Retain reminder note if workflow requires it.
Confirm reimbursement/substantiation path
- Explain reimbursement/substantiation steps using approved language.
- Route denial or missing documentation issues.
- Record evidence location.
Document decision and next steps
- Capture support summary and participant next step.
- Do not store sensitive details unnecessarily.
- Identify follow-up owner.
Escalation or review triggers
- Escalate Medicare, COBRA, subsidy, tax, coverage dispute, payment risk, privacy, or compliance questions.
- Name the review owner.
- Retain handoff record.
Evidence to retain
- Support interaction summary - Retain with the audit file, evidence map, or review record as applicable.
- Plan comparison support note - Retain with the audit file, evidence map, or review record as applicable.
- Enrollment/payment reminder note - Retain with the audit file, evidence map, or review record as applicable.
- Reimbursement instruction note - Retain with the audit file, evidence map, or review record as applicable.
- Escalation or review note - Retain with the audit file, evidence map, or review record as applicable.
- Evidence location - Retain with the audit file, evidence map, or review record as applicable.
Evidence is not saved in this static version. Assign an owner, repeat the process consistently, review exceptions, explain the rationale, and retain copies in the employer file or local project record.
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This checklist supports structured participant guidance. It does not authorize unlicensed plan advice, legal advice, tax advice, Medicare advice, or compliance determinations.